[Predictive factors of short-term mortality in patients with severe head injury].
OBJECTIVE
To define hazard factors of early mortality in severe brain injured patients.


METHODS
An open prospective study was conducted in 125 brain injured patients with initial Glasgow coma score below 8. Different vital parameters were recorded daily during the first 10 days of resuscitation. Computed tomography (CT) scan classification of the Traumatic Coma Data Bank, the Glasgow coma score, the SAPS score and the influence of neurosurgery were assessed.


RESULTS
In exclusive parameters analysis, a Glasgow coma score below 6, the presence of a midline shift of more than 5 mm on the initial brain CT scan, high or mixed density lesion of more than 25 cc, as well as mean blood pressure below 90 mm Hg were respectively correlated with early death. Low mean blood pressure led to low brain perfusion pressure in patients with intracranial hypertension.


CONCLUSIONS
We defined 3 independent predictive factors of early mortality: the Glasgow coma scale, CT scan classification and mean blood pressure below 90 mm Hg. The main goal of the resuscitation in severe brain insult patients must be to obtain a sufficient brain perfusion pressure. This often requires the use of vasoactive drugs.
Rapenne
T
T
Département d'Anesthésie-Réanimation, Hôpital Général, CHU Dijon.
Lenfant
F
F
N'Guyen Kim
L
L
Honnart
D
D
Beaurain
J
J
Freysz
M
M
D000328:Adult; D006259:Craniocerebral Trauma / Q000401:mortality*; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
Facteurs prédictifs de mortalité à court terme chez le patient traumatisé crânien grave.